Symmetrical Erosive Peripheral Polyarthritis in the Late Archaic Period of Alabama.

Symmetrical Erosive Peripheral Polyarthritis in the Late Archaic Period of Alabama

Rothschild B, Turner K, DeLuca M (Arthritis Center of Northeastern Ohio, Youngstown, OH; Dept of Rheumatology, Northeastern Ohio Universities College of Medicine, Rootstown, OH; Dept of Earth Sciences, Carnegie Institute, Pittsburgh, PA), Science 241:1498--1501, 1988

The authors describe the bones of six prehistoric native Americans that exhibited a pathological pattern involving the presence of several kinds of lesions and the absence of several others. The skeletal bones were those of adults who lived from 3,000 to 5,000 years ago. Seventy-eight other well-preserved skeletons were collected from northeastern Alabama.

Each of these skeletons belonged to individuals who lived during the Late Archaic Period along 19 miles of the Tennessee River near Florence, Alabama. While the authors were investigating paleopathologies, they discovered bone lesions corresponding to lesions noted in patients who have rheumatoid arthritis. The authors describe the lesions and indicate that the constellation of gross and radiographic attributes is characteristic of rheumatoid arthritis.

These individuals had polyarticular ante mortem lytic lesions distributed symmetrically among appendicular, primarily peripheral, joints. The skeletal remains were without vertebral syndesmophytes, sacroiliac lesions, or evidence of reactive inflammatory responses. There was extensive diarthrodial involvement, predominantly and evenly affecting hands and feet. Frequently included were the carpals, most severely at the metacarpophalangeal, metatarsophalangeal, and proximal interphalangeal joints. Distal interphalangeal joints were involved minimally. Additional descriptions of involvement were given, and some radiographs were presented.

The authors concluded that these Late Archaic individuals were the earliest-known sufferers of a disease indistinguishable from rheumatoid arthritis. According to the authors, there is an absence of published reports describing equally unambiguous evidence of rheumatoid arthritis in the Old World before 1800. The presence of an indistinguishable arthristis in the precontact New World suggests that this disease may have originated in the New World, entering the Old World after 1492 but before 1785.

The authors further proposed that rheumatoid arthritis may derive from pathogens or allergens native to the New World. The investigators' consideration of the Late Archaic ways of life and other factors implicated tobacco, deer, people, rodents, and dogs as the most likely vectors, pathogens, or allergens responsible for rheumatoid arthritis. Native Americans may have been affected by this disease long before Old and New World connections were established.